C-SECTIONS: FEARS AND CONSIDERATIONS

I was requested by more than a couple of people to do a post on Cesareans – and since currently AT LEAST 32% of women birthing in this country can expect a cesarean, I think it’s a very relevant topic. So…let’s see if I’m up for the task!

I have been to more than a few Cesarean surgeries…both as a doula (not as a midwife: since I became a midwife the hospitals in my area have changed their policies and no longer allow anyone but the father into the OR), and also as a mother (my first pregnancy resulted in a cesarean). There are some common concerns that someone may have when they realize that their baby will be born via cesarean regardless of whether it is a scheduled pre-planned cesarean, or if it is decided on during labor…

Surgeon is testing to make sure mother has adaquate anesthesia!

1. ANESTHESIA CONCERNS “I’m terrified that the anesthesia won’t work and I’ll feel them cutting me!”

I don’t care who you are, that’s a scary thought!! My response to that is to assure you that after anesthesia is in place (usually a spinal or an epidural) and BEFORE they begin the surgery, the surgeon will test to make absolutely certain that you have adequate numbness before moving ahead. The way that they do that is by using what looks like large tweezers….and they *pinch**pinch**pinch* your skin hard all along the intended incision line. If at any pinch you say “Ouch!”…..the room will stop! Now, be warned that with an epidural many women are surprised (not in a good way) to find that they can still FEEL! A spinal usually causes complete paralysis as well as total 100% numbness….but an epidural does not!  With an epidural, you still usually can feel pressure, touching, sensations – just not pain. In other words, if you felt something pushing on your leg you would not be able to say whether I just pressed on it with my thumb…or if I just stabbed you with a knife. Feeling something (pressure, sensation) doesn’t mean you will be experiencing pain…and the surgeon will make certain that you do not feel pain at any point BEFORE starting your surgery.

I am helping to keep mother calm as they prep her belly for surgery.

2. COPING WITH FEARS/STRESS “I learned how to cope/deal with labor – but now I’m having a cesarean and I’m scared and don’t know how to deal with it.”
The coping techniques that you had been using (or learned to use) for labor can be incredibly effective when you are going through the steps of a cesarean. When in labor, you are supposed to take each contraction as it comes, one step at a time, focusing on allowing it to just happen without fighting the sensations, etc. – and that is no different for a cesarean! Take each step as it comes, allowing it to be what it needs to be. IV, drinking the antacid, getting anesthesia, going through the surgery….take each step as it comes, focusing only on that one step and getting through it. Use the same breathing techniques or hypnosis techniques – you can bring your IPOD to the hospital or use aromatherapy in the OR to cover the smells of the surgery (I recommend having your partner get a washcloth from the hospital and putting your aromatherapy on the washcloth so it’s removable if you find it objectionable in the moment) or whatever you planned to use during labor to keep you calm and focused. Also ask yourself: what is it that you’re worried about? Is it the surgery and fear of feeling it? See point #1. Is it recovery? See point #4. Try to remember that this IS still the birth of your baby – this is your baby’s birth story, do everything you can to make it the BEST story possible! Sometimes you can feel ‘out of control’ when it comes to a cesarean…so realizing where you do still have options/control can help with anxieties. (see point #3)
Also recommended is that if this is a scheduled surgery, schedule it for as early as you possibly can in the morning – so that not only do you have less time to stress and get yourself worked up…but you won’t be able to eat/drink before surgery, and as you know you can get very hungry very quickly and it can make you quite miserable! Understand that however early you schedule your surgery, USUALLY they don’t happen at that time since your surgery will be trumped by unscheduled cesareans and vaginal births. Bring something to entertain yourself (puzzle book, cards, magazine) while waiting for your turn in the queue.

Mom looks into dads eyes as they wait for the surgery to begin

3. OPTIONS “I had this elaborate birth plan of things that I wanted in order to make it a good experience – now I don’t have any options.”
You absolutely still have options…and it’s even more important for you to talk to your surgeon about them! You may still have your music playing, may still accept or refuse newborn procedures, you may still see your baby born by either not having a screen up or at least having it lowered/removed for the birth so you can see your baby enter the world. Ask about their policy with regards to medications while in surgery: many MANY places routinely give the mother a drug called Versed immediately after the baby is born. Versed can make you very very sleepy as well as being an amnesiac (most women who have had it talk about their postbirth period as being ‘dreamy’ or ‘vague’). You can demand that no mind altering medications be given to you while in the OR so that you can be fully present for the birth and immediate postpartum period. While you can’t hold baby skin to skin for the first hour as you may have wanted to do (OR’s are kept very cold for numerous reasons), you can advocate for having baby immediately skin to skin for a few moments – and at the very least, daddy can give your baby the human touch by holding baby’s hand or stroking baby’s leg while in the warmer still in the OR. For baby’s sake, the OR is very bright so having daddy shield baby’s eyes can allow baby to open their eyes, making eye contact with daddy and bringing gentleness to the birth. Find out what the policy is for the baby immediately after birth: most places where I am keep mom and baby together and they go as a unit to the recovery area, but there are (unfortunately) still a few that demand that baby go to the nursery for a few hours “for observation”. Just remember that this is YOUR baby and he/she does not belong to the hospital. They are required to follow hospital policies, but you have the right to accept or refuse any of their policies – having a cesarean does not change this.

4. RECOVERY “I’m afraid of dealing with recovering from a cesarean…”
Well, yeah…it’s gonna suck. Sorry, but if I’m not honest then you can’t trust me, right? It’s not fun and it’s going to hurt – but immediately after surgery you can tell yourself that this is as bad as it is going to get! Every day your body will be healing, every day is a step towards being healthy once more. It’s amazing how much better you will feel in only a week….and so much better a week after that! Also remember that without moving it’s not that bad, so it’s not like you’re in constant pain. Getting up and getting down is the worst of it – standing, walking around, or laying down is not that bad.
NOTE TO WELL MEANING FRIENDS AND FAMILY: Coughing, sneezing, and laughing are AWEFUL! Please do not make a post-cesarean mama laugh hard for many days (week?) after surgery….if you love them!

Things that can help your recovery:
• Walk walk walk….and keep walking. Walking isn’t that painful (it’s getting up in order to walk that’s challenging), and walking will help clear your system of anesthesia as well as prevent/help abdominal gas that can be so painful. Walk…and keep walking…even when you don’t want to. Walk walk walk.
• Keep taking your Colace – a stool softener to help you not have to use abdominal muscles while having a bowel movement. Keep in mind that anesthesia notoriously slows down your bowels, so the Colace can really be helpful for that as well.
• Don’t be afraid to continue your oral pain medications – you will be sent home with some form of pain medication and many women are afraid to take it for fear of what it could do to their breastfed baby. Don’t worry about that…the medications given are totally fine with breastfeeding.
• SLEEP! Your body is caring for a baby, making milk, and healing from a major surgery….get as much rest and sleep as you possibly can, being tender with your body – it’s been through a lot!!
• Steri-strips, Dermabond, or sutures INSTEAD OF STAPLES! Most surgeons already opt to close your skin incision with the less invasive methods, but many surgeons still use staples which cause trauma to the tissue as well as require an uncomfortable removal days later. Save yourself the trouble and see if they can close your belly with one of the gentler alternatives.

Having a cesarean is almost universally a disappointment and can bring with it a whole new set of anxieties and concerns – but while it may not be your ideal situation, there are definitely things that you can do to make it a better situation! I am sorry that you may find yourself facing a cesarean, but I hope that this post has given you some information or ideas to help making it a better experience for you and your family.

6 Comments

  1. Kelli wrote:

    Thank you for this. I realized recently that I need a plan for this possibility because its a huge fear of mine, its hard not to cry at the thought, so I think I better prepare and calm myself or the universe might dish out this lesson in surrendering fear firsthand.

    When a c-section is needed NOW, how can I ask for what I want? I picture a mad dash and panic to GET BABY OUT NOW. So what can I do to make sure that they (don’t strap down my arms, use the anestesia I prefer, let me see the birth, let me see baby if possible, have dad stay with baby, keep my placenta, avoid Versed, avoid staples, ect)basically treat me the way I want if this is happening FAST, like I imagine would happen with say, a prolasped cord? Being unlikely doesn’t mean it wouldn’t make a difference to prepare for it.

    Sunday, March 28, 2010 at 8:15 pm | Permalink
  2. elfanie wrote:

    Kelli:
    the panic to get the baby out NOW so very very rarely happens…truly. Almost always there are hours and hours of decisions and waiting….
    but when the decision is to get the baby out NOW, then is when the dad can be of great help. He knows you, together you have hopefully discussed your vision for the birth, and he can advocate for you and for baby.
    (in fact, I remember reading the blog of a dad who was a football player whose wife had a cesarean…and when they tried to take the baby out of the room the dad physically blocked the room and told them that they were NOT going to take the baby out of the room, that baby was going to stay with mom. They started to argue with him, but he just stood with his hands on his hips and baby stayed with mom.

    but even before you get to that point….I’d write a cesarean birth plan, on a separate sheet to whip out if it looks like things are headed that direction – as well as make a mental note of what is really important to you and verbalize it a couple of times through the experience. Again, remember that it’s rarely RARELY ‘fast’….and if it is, you can be happy that dad is there. =)

    Sunday, March 28, 2010 at 8:50 pm | Permalink
  3. Jenny David wrote:

    I agree with Steph about writing a cesarean birth plan… Many of my students put theirs right on the back of their “Plan A” birth plan.

    Monday, March 29, 2010 at 12:23 pm | Permalink
  4. Becky wrote:

    Thank you so much for writing this Stephanie! You’ve done a wonderful job of being honest yet reassuring…without coming off at all like your passing judgment on those who end up with a c-section. (Not that you ever would, but some articles/blogs I’ve seen can tend to come off that way).
    Also I had no idea that I could request to get stitches instead of staples…my old doctor always did stitches and nurses always praised him for being one of the very few who “went to the trouble” of doing that…but now that I have a different doc I was worried I’d just have to deal with getting staples. Hopefully I’ll get a chance to put in my request that he consider doing one of the other options.

    Thanks again for this great blog entry!

    Monday, March 29, 2010 at 2:11 pm | Permalink
  5. Tni wrote:

    My first pregnancy I had to have a c-section. What are some of the things that could hold me back from having a VBAC the next time around?

    Thursday, April 1, 2010 at 1:09 pm | Permalink
  6. Callie wrote:

    I know this post if a few years old but I thought maybe you would like to update for any new soon-to-be Mamma’s that happen read your blog. You talked about not being able to do skin to skin in the OR because of the temperature. There are actually quite a few hospitals now who do allow skin to skin in the OR. They place the baby on Moms chest and cover them with blankets from the warmer. It is something that I feel women should know they can request if they desire.

    Sunday, January 27, 2013 at 9:34 pm | Permalink

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